Combination intra-medullary and extra-medullary fracture stabilization with aligning arm

ABSTRACT

A device provides a variety of fracture fixation options should a fracture occur after total hip arthroplasty or total knee arthroplasty, and provides associated methods and apparatus for application of provided fixation. The ability to pre-engineer fracture fixation contingent solutions into femoral or tibial components provides for a distinct clinical advantage in the planning and execution for periprosthetic fracture fixation. Said methods and apparatus include targeting devices which allow for intimate association of fixed angle locking screws in pre-drilled holes in an existing prosthetic, femoral nail, or other components including additional fixation components. Such apparatus and methods further include the use of alignment devices and other components to allow for ease of repair of fractures utilizing the pre-engineered solutions.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of co-pending U.S. patent applicationSer. No. 17/325,319 filed May 20, 2021 for “COMBINATION INTRA-MEDULLARYAND EXTRA-MEDULLARY FRACTURE STABILIZATION WITH ALIGNING ARM, which is acontinuation of U.S. patent application Ser. No. 17/145,512, filed Jan.11, 2021 (now U.S. Pat. No. 11,000,380), which is a continuation of U.S.patent application Ser. No. 17/120,944 filed Dec. 14, 2020 (now U.S.Pat. No. 11,103,605), which is a continuation of U.S. patent applicationSer. No. 16/445,353 filed Jun. 19, 2019 (now U.S. Pat. No. 10,874,520)for COMBINATION INTRA-MEDULLARY AND EXTRA-MEDULLARY FRACTURESTABILIZATION WITH ALIGNING ARM, which is a continuation of co-pendingU.S. patent application Ser. No. 15/893,911 filed Feb. 12, 2018 (nowU.S. Pat. No. 10,357,370) for PERIPROSTHETIC FRACTURE MANAGEMENTENHANCEMENTS which is a continuation of U.S. patent application Ser. No.15/372,609 filed on Dec. 8, 2016 (now U.S. Pat. No. 9,913,722) by DanielNick Segina, James A. Proctor, Jr. and James A. Proctor, III forPERIPROSTHETIC FRACTURE MANAGEMENT ENHANCEMENTS, which is a continuationof U.S. patent application Ser. No. 15/068,923 filed on Mar. 14, 2016(now U.S. Pat. No. 9,522,066) by Daniel Nick Segina, James A. Proctor,Jr. and James A. Proctor, III for PERIPROSTHETIC FRACTURE MANAGEMENTENHANCEMENTS, which is a continuation of U.S. patent application Ser.No. 14/200,678 filed on Mar. 7, 2014 (now U.S. Pat. No. 9,345,523) byDaniel Nick Segina, James A. Proctor, Jr. and James A. Proctor, III forPERIPROSTHETIC FRACTURE MANAGEMENT ENHANCEMENTS, which is a continuationof U.S. patent application Ser. No. 13/398,512 filed on Feb. 16, 2012(now U.S. Pat. No. 8,709,092) by Daniel Nick Segina, James A. Proctor,Jr. and James A. Proctor, III for PERIPROSTHETIC FRACTURE MANAGEMENTENHANCEMENTS, which claims the benefit of U.S. Provisional ApplicationNo. 61/443,292, filed on Feb. 16, 2011.

The entire teachings of the above applications are incorporated hereinby reference.

BACKGROUND OF THE INVENTION 1. Field

The present disclosure relates generally to methods and apparatus forallowing for improvements in the repair of Periprosthetic fractures. Insome embodiments, these improvements the inclusion of features withinthe implanted parenthesis allowing for use of an apparatus for effectiveand efficient alignment and installation of one or more fracturestabilization components and related components.

2. Related Art

The current state of fixation of periprosthetic fracture revolves arounddevices that are designed to avoid originally placed femoral or tibialcomponents. With a multitude of different fracture patterns that couldclinically exist, current solutions for the variability of fracturepatterns revolve around the use of either an external bone plate or aninternal medullary rod/nail.

The foregoing describes approaches for conventional periprostheticfracture management. Such approaches often result in sub-optimalprognosis as compared with fracture management in the absence of aconventional prosthesis. Additional impacts to the patient recovery timeresult from significantly more invasive procedures being required forthe application of such conventional fracture management devices.

SUMMARY

Embodiments of the current invention provide for pre-engineered fracturefixation contingent solutions into femoral or tibial components,resulting in a distinct clinical advantage in the planning and executionfor periprosthetic fracture fixation. Additional embodiments include apre-engineered solution to intimately associate with the previouslyplaced total hip arthroplasty or total knee arthroplasty and further insome embodiments utilize approaches for allowing targeting of requiredfasteners, screws and the like, using a mechanically associatedrelationship to the existing prosthetic, or other components.

Specific embodiments of this invention are related to the design ofprosthetics for artificial hip and knee replacement, the repair ofPeriprosthetic fractures, and associated methods and apparatus for usein the application of fracture stabilization components. Additionalembodiments provide for a variety of fracture fixation options should afracture occur after total hip arthroplasty or total knee arthroplasty.

To support the application of such fixation options in specificembodiments provide for apparatus and methods to include the use ofalignment devices and other components to allow methods for ease ofrepair of Periprosthetic fractures utilizing the pre-engineeredsolutions. Such targeting devices are required in specific circumstancesas the prosthetics may prevent x-ray imaging and consequently free handalignment. Specific embodiments of the aforementioned alignmentdevice/outrigger may be composed of carbon fiber or other materialstransparent to imaging technology utilizing radio lucent materials.

In one embodiment, a method for repairing a periprosthetic fracturecomprises mounting an aligning device in mechanical registration with anin situ prosthetic component and locking a fracture stabilizationcomponent, and aiming arm, the aligning device and the in situprosthetic component in mechanical alignment, utilizing the aiming armto provide alignment of one or more mechanical cannula with one or moreprosthetic component interfaces and securing one or more bone fracturesegments associated with the periprosthetic fracture with said fracturestabilization component using screws, wherein the fracture stabilizationcomponent and the prosthetic component are further mechanically secured.

In another embodiment, a periprosthetic fracture device comprisesmounting an aligning device in mechanical registration with an in situprosthetic component and locking a fracture stabilization component, andaiming arm, the aligning device and the in situ prosthetic component inmechanical alignment, utilizing the aiming arm to provide alignment ofone or more mechanical cannula with one or more prosthetic componentinterfaces and securing one or more bone fracture segments associatedwith the periprosthetic fracture with said fracture stabilizationcomponent using screws, wherein the fracture stabilization component andthe prosthetic component are further mechanically secured.

In another embodiment, the prosthetic component further comprises athreaded coupling point for receiving the aligning device.

In another embodiment, the prosthetic component further comprises aguide wire.

In another embodiment, the aligning device and the aiming arm are asingle component.

In another embodiment, the prosthetic component is a modified femoralcomponent, and wherein said femoral component interfaces with aperiprosthetic distal femoral polyaxial locking plate.

In another embodiment, the prosthetic component is a modified tibialtray component.

In another embodiment, the component interface is notched or keyed forproper rotational alignment.

In another embodiment, the mechanical registration is a notchedmechanical interface between a femoral nail and the prostheticcomponent.

In another embodiment, the aligning device and the aiming arm aremechanically assembled components.

In another embodiment, the fracture stabilization component comprisesone of the following: a femoral nail, tibial nail, femoral plate, ortibial nail.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing will be apparent from the following more particulardescription of example embodiments of the invention, as illustrated inthe accompanying drawings in which like reference characters refer tothe same parts throughout the different views. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingembodiments of the present invention.

FIG. 1 is an illustration of a first defined fracture below the hipprosthesis.

FIG. 2 is an illustration of an embodiment including: Modified FemoralComponent to Accommodate Cannulated Outrigger, Custom Modular Plate andTargeting Device.

FIG. 3 is an illustration of an embodiment including: AlternativeModified Femoral Component to Accommodate Cannulated Outrigger, CustomRetrograde Nail and Targeting Device.

FIG. 4 is an illustration of an embodiment including: Magnified detailof Modified Femoral Component Tip to Accommodate Retrograde Nail.

FIG. 5 is an illustration of a periprosthetic distal femur fracture.

FIG. 6 is an illustration of an embodiment including: Angular StableRetrograde Periprosthetic Distal Femoral Nail.

FIG. 7 is an illustration of an embodiment including: Detailed LateralProjection of Modified Femoral Component (601).

FIG. 8 is an illustration of an embodiment including: Detail of (703)Angular Stable Set Assembly with Free Rotating Angular Interface.

FIG. 9 is an illustration of an embodiment including: Distal AxialProjection of FIG. 6: Angular Stable Retrograde Periprosthetic DistalFemoral Nail.

FIG. 10 is an illustration of an embodiment including: Distal FemoralPeriprosthetic Plate Fixation with contingent prosthetic interface.

FIG. 11 is an illustration of an embodiment including: LateralProjection of Distal Femoral Periprosthetic Plate Fixation withcontingent prosthetic interface.

FIG. 12 is an illustration including: a fracture below the tibial tray.

FIG. 13 is an illustration of an embodiment including: Modified TibialTray to accommodate contingent fracture management.

FIG. 14 is an illustration of an embodiment including: LateralProjection of (FIG. 13) Modified Tibial Tray to accommodate contingentfracture management.

FIG. 15 is an illustration of an embodiment including: 2D rendition of(1203) Prosthetic Tibial Tray.

FIG. 16 is an illustration of an embodiment of Contingent ProstheticTibial tray accommodation for Proximal Tibial Locking Plate formanagement of Periprosthetic fracture management.

FIG. 17 is an illustration of a Lateral Rendition of (FIG. 16) anembodiment of Contingent Prosthetic Tibial tray accommodation forProximal Tibial Locking Plate for management of Periprosthetic fracturemanagement.

FIG. 18 is an illustration of an embodiment of Tibial ContingentAccommodation and Mounting of Tibial Plate.

DETAILED DESCRIPTION OF THE INVENTION

A description of example embodiments of the invention follows.

FIG. 1: Problem #1—Fracture Below Hip Prosthesis

FIG. 1 shows an existing problem in the industry of a fracture below ahip prosthesis. The prosthesis 101, articulates with the hip joint 104,as is known within the industry. Furthermore, the Hip Prosthesis 101 isimplanted within the proximal femur 102. Periprosthetic Femur fracture103 occurs post implantation of the prosthesis 101, into the proximalfemur. The current challenge within orthopedic surgery is the fixationof a fracture after implantation of Hip Prosthesis 101. The metallicimplant obscures the capacity to provide for fixation through the boneby occupying the inner space of the medullary femoral canal. Clinicalsolutions attempt to avoid the femoral prosthesis 101 by providing forscrew trajectories away from the implant or options for circumferentialwire fixation around the implant. While the current fracture pattern 103is described within, this does not and is not intended to limit thescope of the application of the embodiments of this invention.

FIG. 2: Embodiment of Solution #1—Modified Femoral Component toAccommodate Cannulated Outrigger, Custom Modular Plate and TargetingDevice.

This section discusses one embodiment to address the problem of FIG. 1,depicted in fracture pattern 103.

Modified Femoral Component 201 is implanted into the proximal femur.

Femoral component 201 with hollow core 212 to accommodate guide aTargeting Guide Wire 202 is depicted to provide for a reference pointfor an aligning device, such as Cannulated Outrigger 203. This allowsfor alignment and an intimate association between Femoral Component 201and an aligning device, such as Cannulated Outrigger 203, resulting in aunique interface reference point 211. Interface Reference point 211 mayutilize keyed interfaces between an aligning device, such as CannulatedOutrigger 203 and between Femoral Component 201 so as to allow for afurther angular or rotational reference. As a result, spatialorientation is now predetermined and referenced off of the previouslyimplanted Femoral Component 201. With a fracture stabilizationcomponent, such as the Cannulated Outrigger 203 mated to ModifiedFemoral Component 201, an aiming arm, such as a Distal Targeting Device205 can then be assembled to provide for appropriate and accuratetargeting of Fixed Angled Locking Screws 206; targeting through ScrewAlignment Cannulae 207 thus providing a mechanism for security fixationof a fracture stabilization component, such as the Custom Modular Plate204A, 204B, and 204C. Clinical solutions for Coupling Point 208represent a mating mechanism between the Cannulated Outrigger 203 and anaiming arm, such as the Distal Targeting Device 205. This intimate fit,once again, assures appropriate targeting of the Fixed Angled LockingScrews 206 through the Modified Femoral Component 201 which revolvesaround fixation. The Modified Femoral Component 201 is implanted intothe Native Femur depicted as 209. The interface between Modified FemoralComponent 201 and Cannulated Outrigger 203 is described via a threadedCannulated Outrigger Interface 211. The cannulation of this interfacehappens over a hollow core 212 which is inserted through CannulatedOutrigger 203 and the Modified Femoral Component 201.

The capacity for the Modified Femoral Outrigger 203 to be mated to theFemoral Component 201 provides for accurate reference point to thustarget the screws depicted in 206. This overcomes the challenge ofalignment, which is not referenced, and presents a difficult clinicalchallenge for targeting the appropriate screw 206 and implant 201interfaces. The clinical benefits extend to the decreased surgical timedue to known reference point between Modified Femoral Component 201 and203; in addition to decreased surgical trauma and surgical dissection inattempts to find the appropriate alignment between Modified FemoralComponent 201, Plate 204A, B, and C, and Screw 206. The capacity tolimit surgical time as well as surgical exposure necessarily translatesinto decreased cost as well as decreased patient morbidity.Additionally, improved mechanical fixation would be enhanced due toaccurate targeting and interface between Modified Femoral Component 201and a fracture stabilization component, such as Modular Plate 204A, B,and C as well as Screws 206. Femoral Component 201 would be inserted atthe time the patient would be undergoing a total hip arthroplasty. Theutility of the interface 211 would come into play after a periprostheticfracture was to occur. The insertion of Guide Wire 202 into ModifiedFemoral Component 201 to facilitate the interface of CannulatedOutrigger 203 would be temporary. This interface can then be uncoupledafter fixation of the fracture has occurred through the use of afracture stabilization component, such as the Modular Plate 204A, B, andC and screw fixation with Screw 206. The pre-engineered geometry inModified Femoral Component 201 would be done at the time of manufactureof said component. Additionally, the Interface 211 as well as the screwholes for Screw 206 would be incorporated into Component 201 prior toimplantation, thus ready to be utilized at a future date shouldperiprosthetic fracture of Native Femur 209 occur after total hiparthroplasty. Necessitates it is inserted into the Modified FemoralComponent 201 and around the prosthesis either via screws in atrajectory that does not interfere with the Prosthesis 101 or wires thatwrap around the bone properly, providing for a method of fixation thatonce again does not interfere with Prosthesis 101. It should be notedthat this deals with only one specific fracture pattern of the proximalfemur below a Hip Prosthesis 101. Other potential fracture patterns doexist around other prosthetic implants which will be addressed infurther figures in this document.

FIG. 3: Solution #2—Alternative Modified Femoral Component toAccommodate Cannulated Outrigger, Custom Retrograde Nail and TargetingDevice

FIG. 3 represents an alternative embodiment of the modified femoralcomponent 301 and associated components. This embodiment of the modifiedfemoral component accommodates a custom retrograde Femoral Nail 304 inthe treatment of a periprosthetic distal femur fracture. The modifiedFemoral Component 301 would be inserted at the time of total hiparthroplasty; this component is utilized as a component of fixation ofsaid fracture of the Native Femur 309 after total hip arthroplasty. TheGuide Wire 302 is inserted through the Modified Femoral Component 301which contains an inner cannulation component. The guide wire isadvanced to the end of the Native Femur 309 and goes past the fracturesite. This guide wire is then be utilized to direct the CustomRetrograde Femoral Nail 304 so that it is placed over the tip of theModified Femoral Component 301 to provide for an engagement andsubsequently secure fracture fixation. The interface between theModified Femoral Component 301 and the Custom Retrograde Femoral Nail304 will be further depicted in FIG. 4 which is labeled in the currentdiagram as 311. Some embodiments will provide for a keyed interface 311between the Modified Femoral Component 301 and the Custom RetrogradeNail 304. The insertion of the Guide Wire 302 to accommodate and guidethe Retrograde Femoral Nail 304 takes place at the time of surgicalrepair of the fracture. Once the guide wire has been passed to the endof the Native Femur 309 an opening at the distal femur would occur toprovide for an entry portal of the Retrograde Femoral Nail 304. Attachedto the Retrograde Femoral Nail 304 would be an aligning device, such asthe custom Cannulated Outrigger 303. This outrigger is cannulated toaccommodate the Guide Wire 302 and the Guide Nail 304 to the appropriateposition at the tip of the Customized Modified Femoral Component 301.Attached to 303 will be an aiming arm, such as the Proximal TargetingDevice 305. The adjoinment of 305 to 303 would occur at Coupling Point308. Once an aiming arm, such as the proximal targeting device, is inplace it would provide for appropriate and predetermined targeting forthe Fixed-Angled Interlocking Screws 306 both at the proximal and distalaspect of the fixation. The screws would align with the fixation device,customized Retrograde Femoral Nail 304, with the use of an aiming arm,such as the proximal targeting device, and the Screw Alignment Cannula307. A cutaway diagram reveals a three-dimensional profile of an aimingarm, such as Proximal Targeting Device 305, which is labeled 312 in thisfigure. The benefits of this embodiment provide for a biologicallyfavorable method of fixation that is amenable to minimal soft tissuestripping thus preserving biology around the fracture and helpingpromote rapid healing. Additionally, surgical time would besignificantly shortened. Biomechanical favorability is also achievedwith the overlap interface that is obtained between the CustomizedModified Femoral Component 301 and the Custom Retrograde Femoral Nail304. Once again this interface, labeled 311, will be further depicted inthe next drawing.

In addition, Modified Femoral Component distal tip 311, may include (inspecific embodiments) a specific alignment key feature which allows foralignment of pre-drilled holes which may be present in the CustomRetrograde Femoral Nail 304, and the Modified Femoral Component 301,such that a keying feature angularly aligns with a keying featurepresent in the Retrograde Femoral Nail 304. One such keying feature maybe a notched interface, allowing for proper rotational alignment.

FIG. 4: Magnified Detail of Modified Femoral Component Tip toAccommodate Retrograde Nail

In FIG. 4 the depiction represents the interface on a magnified scalebetween the Modified Femoral Component 301 and the Custom RetrogradeFemoral Nail 304. The interface is further specified as 311. In thisdepiction, a tapering and smaller diameter at the tip of 301 is designedto provide for a unique and overlapping interface between the ModifiedFemoral Component 301 and the Retrograde Femoral Nail 304. This overlaphelps achieve mechanical stability by preventing a stress riser thatwould occur if no overlap were to exist. Additionally, a predeterminedtrajectory would be placed and aligned to accommodate the Angular StableInterlocking Screw 306. This would interface through the cortical bonedepicted as 401 as well as the Custom Retrograde Femoral Nail 304 andthe Modified Femoral Component 301 and subsequent Modified FemoralComponent Distal Tip 311. The ability to target this screw and align itappropriately would be facilitated through the attachment of an aligningdevice, such as the Cannulated Outrigger 303 depicted in FIG. 3 alongwith an aiming arm, such as the Proximal Targeting Device 305 andsubsequent Alignment Cannula 307.

FIG. 5: Problem #2—Periprosthetic Distal Femur Fracture Above aProsthetic Total Knee Arthroplasty.

Depicted in FIG. 5 is the clinical scenario where a fracture would occurabove a previously inserted total knee arthroplasty. The fracture wouldoccur in the Native Bone 504 and be depicted by the Fracture Pattern501. Please note that this is one of potentially many different fracturepatterns that may exist and this is only one embodiment of this saidfracture. The Femoral Component 502 would be placed onto the NativeFemur 504 at the time of total knee arthroplasty. Similarly, the TibialComponent 305 would be placed into the Native Tibia 505 at the time oftotal knee arthroplasty to articulate the Femoral Component 502.Additionally depicted is the Native Fibula 506. The clinical problemthat will be subsequently discussed will be to address said fracture 501above a total knee arthroplasty otherwise known as a periprostheticdistal femur fracture.

FIG. 6: Embodiment of Solution #3—Angular Stable RetrogradePeriprosthetic Distal Femoral Nail

In an embodiment of one of the current inventions, the alignment devicesincluding the Cannulated Outrigger 603, Proximal Targeting Device 605,Angular Stable Screw Alignment Cannula 606, and Couple Point 604 can beconstructed out of a radiolucent material to provide for an avenue ofX-ray visualization to help assure appropriate alignment as well asplacement. In this embodiment, alignment device required as theprosthetics prevent x-ray imaging and free hand alignment. This is a keyadvantage and solution to an existing problem. Also note that thealignment device/outrigger may be composed on carbon fiber or othermaterials transparent to imaging technology using radio lucent materialsin some embodiments.

FIG. 7: Detailed Lateral Projection of an Embodiment of a ModifiedFemoral Component (601)

Depicted in this drawing is a lateral projection of an embodiment of theModified Femoral Component 601 with the Custom Angular Stable RetrogradeFemoral Nail 602 being inserted as would happen in a clinical scenarioduring fracture repair. The insertion is to the point where theinterface is occurring between the Modified Femoral Component 601 andthe Custom Retrograde Angular Stable Femoral Nail 602. The alignment aswell as insertion would be facilitated over Guide Wire 610 and throughthe attached Custom Outrigger 603, aiming arm, such as ProximalTargeting Device 605, Alignment Cannula 606, and Coupling Point 604.Depicted out of plane is the Angular Stable Interlocking Screw 607 whichwould traverse the region labeled 702 and interact with the modificationof Modified Femoral Component 601, depicted as 701. The interface andalignment is secured between the Custom Retrograde Femoral Nail 602 andan aligning device, such as the Cannulated Outrigger 603 by a ThreadedInterface 608. The design of Subcomponent 601, that is labeled 701,would be made in a way to accept the Retrograde Femoral Nail 602 as wellas provide for the traversing of the Angular Stable Interlocking Screw607. The geometry is designed, as such, to control the coronal andsagittal plane angulatory forces to help maintain alignment. The finalcapacity to be able to maintain this alignment would be facilitated bythe angular stable set assembly end cap with three rotating angularinterfaces. Further detail of this object will be described in FIG. 8.Further details around the Area 701, which is specifically described ascontingent prosthetic distal femoral nail interface, will be provided.The design of 701 would be manufactured into the Component 601 at thetime of initial manufacturing. This modification, 701, would exist atthe time of total knee arthroplasty and be present as a contingentsource of fixation with angular stabilization should a fracture of thedistal femur arise. The geometry of 701, once again, would be to acceptthe Angular Stable Interlocking Screw 607 as well as the angular stableset assembly end cap with Free Rotating Angular Interface 703. Theaddition of these two devices through the portal labeled 702 would thenbe able to obtain and maintain sagittal as well as coronal planestability. This embodiment encompasses the distinctive benefits of both703 by itself, and 701 by itself, as well as combined. Further use of701 as a contingent structure, and separately as a device to accept thenail in operation are further contemplated.

FIG. 8: Detail of an Embodiment of (703) Angular Stable Set Assemblywith Free Rotating Angular Interface

Depicted in FIG. 8 is a breakdown of an embodiment of the components ofthe angular stable set assembly end cap with free rotating angularinterface. This end cap would be inserted through the Custom Outrigger603 over the Guide Wire 610. It would then interface through thesubcomponent of the Modified Femoral Component 601, labeled as 701. Thisinterface would then provide for a frictional fit to secure the AngularStable Interlocking Screw 607. Depicted in FIG. 8 is 703A which is theangular portion of the angular state assembly end cap. This is depictedas having a smooth surface to provide for a free-glide insertion withoutinterfacing with underlying threads. Allowing for the insertion would bea Threaded Component 703B. This would interface the threaded componentof the Custom Retrograde Femoral Nail 602 at the region labeled 608 inFIG. 7. The threaded capability of this component provides for athreaded and locked frictional fit to secure the interface betweenSubcomponent 703 of the angular stable set assembly with free rotatingangular interface and the Angular Stable Interlocking Screw 607. Freerotation of this device would be allowed through the interfacecontaining a smaller diameter to engage, labeled 703C. The entireAssembly 703A, 703B, and 703C, once placed over the Guide Wire 610,would be screwed into position using the Cannulated Screwdriver 801.

FIG. 9—Distal Axial Projection of FIG. 6 and an Embodiment of an AngularStable Retrograde Periprosthetic Distal Femoral Nail

Depicted in FIG. 9 is an embodiment of the current invention includingan axial projection viewing the inner-connular region of the ModifiedFemoral Component 601. Once the Retrograde Femoral Nail 602 is insertedthrough the inner-connular notch over Guide Wire 601, and facilitated byan aligning device, such as the Cannulated Outrigger 603, an AngularStable Interlocking Screw 607 would then be inserted. This insertionwould be introduced with the Alignment Cannula 606 and placed through anaiming arm, such as the Proximal Targeting Device 605. The interfacewould occur at the modified subcomponent of Modified Femoral Component601, labeled 703. The projection of 703 in this diagram is a combinationof 701 and 702 from FIG. 7. The purpose of this depiction is todemonstrate that no alteration of the surface of the Modified FemoralComponent 601 would occur at the time that the fracture fixation wouldtake place, using the insertion of Modified Retrograde Femoral Nail 602and the placement of Angular Stable Interlocking Screw 607.

FIG. 10: Solution #4—Distal Femoral Periprosthetic Plate Fixation withContingent Prosthetic Interface

Depicted in this diagram is an alternative embodiment of a method offixation to deal with a periprosthetic distal femoral fracture. Thisfracture would be of Native Bone 504 and is depicted as Fracture Pattern501. The Modified Femoral Component 1001 would be placed at the time oftotal knee arthroplasty. Modifications would be in place at the time ofmanufacture of Modified Femoral Component 1001 and be available for acontingent fracture fixation should Fracture 501 occur after total kneearthroplasty takes place. The Modified Femoral Component 1001 is furtherdescribed as a modified femoral component that interfaces with customangle stable periprosthetic distal femoral, polyaxial locking plate. InFIG. 10, the Distal Plate Outrigger 1003 is shown to connect to theCustom Angular Stable Periprosthetic Distal Femoral Polyaxial LockingPlate 1004 through the 1003/1001 custom interface—prosthetic contingentmounting interface. Through Couple Point 1008 Proximal Targeting Device1005 is depicted providing for cannula placement for Screw AlignmentCannula 1007. Through 1007 there would be placed some Fixed AngledLocking Screws 1006 which would interface and subsequently thread intoPlate 1004. Distally, once 1009 prosthetic contingent mounting interfaceis installed to 1004 as well as 1001, the predetermined alignment wouldbe allowed for the placement of Central Distal Angular StableInterlocking Screw 1011 through the Central Distal Angular Stable ScrewPortal 1010.

This alternative embodiment of fixation for Distal Femoral Fracture 501utilizes a plate-and-screw construct to achieve axial, sagittal, as wellas coronal plane alignment maintenance. The capacity to interface withModified Femoral Component 101 allows for no reliance upon the integrityof the Distal Femoral Bone 504, but rather the ability to directlyinterface and adjoin to Modified Femoral Component 101 so as to maintainabove-said alignments in all three planes. Fracture fixation andalignment is also further maintained with the insertion of additionalLocking Screws 1006 above and below the Periprosthetic Fracture 501. Theclinical advantage of this device once again provides for minimallyinvasive exposure of the distal femur and soft tissue preservation forenhanced biologic preservation around Fracture Site 501. Aiming arm,such as the Proximal Targeting Device 1055 would reside outside the skinof the soft tissue envelope of the Femur 504 and guide 1007, screwalignment cannula, through the skin to align appropriately with theCustom Angular Stable Periprosthetic Distal Femoral Polyaxial LockingPlate 1004. Screws would then be inserted through the Plate 1004 andUnderlying Bone 504 and lock into position.

FIG. 11: Lateral Projection of an Embodiment of a Distal FemoralPeriprosthetic Plate Fixation with Contingent Prosthetic Interface

This figure details an embodiment of the three-phase interface betweenModified Femoral Component 1001, the custom angular stableperiprosthetic distal femoral plate and the Distal Femoral Outrigger1003. Depicted in 1009 is the interface that allows for the adjoining of1003 to Modified Femoral Component 1001 as well as the Interposed Plate1004. The ability to interface all three components provides for theability to specifically target an angular stable interlocking screwdepicted as 1011 in FIG. 10. With the adjoining of these components afixed-angled construct would exist between the Modified FemoralComponent 1001 and the Custom Angular Stable Plate 1004; thus being ableto achieve the maintenance of axial, sagittal, as well as coronal planealignment and avoid the reliance upon underlying native bone quality.Additionally depicted is a Central Pole 1010 that would accommodate alarge central angular stable interlocking screw for additional fixation.This screw may be placed in a polyaxial locking capacity. Of note, isthe modifications of the Distal Femoral Component 1001 to accommodatethe adjoining interface to Custom Angular Stable Locking Plate 1004 andthe modifications to Modified Femoral Component 601 to accommodate theCustom Retrograde Femoral Nail 602 can be made within the same implant.With both options available for either plate or nail fixation, a varietyof different fixation strategies can be accommodated by the sameModified Femoral Component. Once again, these modifications would takeplace at the time of manufacture of the Modified Femoral Component601/1001 and not interfere with the articulation of the planned totalknee arthroplasty. The contingencies would remain in place and providefor fixation options should a distal femoral fracture depicted as 501,occur.

1009 allows for the joining of the 1003 outrigger to 1004 plate, andadditionally provides for the joining of 1001 femoral component to 1004plate.

In one embodiment, a screw is used to mount the outrigger, through theplate's holes top the prosthetic. 1009 allows for the joining of the1003 outrigger to 1004 plate, and additionally provides for the joiningof 1001 femoral component to 1004 plate. In one embodiment screws areused to mount the outrigger, through the plate's holes on top of theprosthetic. In this embodiment, several novelties in the prostheticinclude contingent accommodations for femoral fracture managementprocedures, and further the specifics of those accommodations and theiruse at the time of the repair, and the details of the attached devicesand methods for using the features provided.

FIG. 12: Problem #3—Fracture Below Tibial Tray

Depicted in FIG. 12 is the Native Tibia 1201 as well as potential futurefracture of the proximal tibia, labeled 1202. Please note that theFracture Pattern 1202 is only one potential fracture pattern that couldexist below the tibial tray component of the total knee arthroplasty.The tibial tray component is labeled in this diagram as 1203.

FIG. 13: Solution #5—Modified Tibial Tray to Accommodate ContingentFracture Management

Depicted in FIG. 13 is one embodiment of the fracture management deviceto address fracture of a Tibial Component 1203 with the fracturedepicted as 1202. A Guide Wire 1301 would be inserted at the time offracture fixation through the Tibial Component 1203 through theInterface 1307. Over this guide wire would be placed a Tibial NailFixation Device 1309 with the insertion of 1309 being facilitatedthrough an aligning device, such as a Cannulated Outrigger 1302 andaiming arm, such as Proximal Targeting Device 1303. Further details of acoupling point between 1302 and 1303 are depicted as 1304. Providing forappropriate targeting and placement of the Fixed-Angled Locking Screw106 would be the Screw Alignment Cannula 1305 inserted through theProximal Targeting Device 1303. The advantage of this design providesfor medullary fixation of the fracture of the Native Tibia 1201 with thefracture pattern depicted as 1202. The ability to have the ContingentProsthetic Accommodation Portal 1307 be in place prior to the fractureprovides a significant clinical advantage for potential fracturefixation. The biomechanical and biological advantages of medullaryfixation for a fracture pattern depicted as 1202 of the Native TibiaBone 1201 are extensive. Ease of operation, maintenance of the currenttotal knee arthroplasty, as well as preservation of biology are alldistinct advantages. The addition of biomechanical favorability with themedullary implant is also noted.

FIG. 14 Lateral Projection of (FIG. 13) Modified Tibial Tray toAccommodate Contingent Fracture Management

FIG. 14 represents a Lateral Projection of (FIG. 13) an embodiment ofModified Tibial Tray to accommodate contingent fracture management.Through this lateral projection the Modified Tibial Nail 1309 isinserted through the Customized Tibial Prosthetic Tray 1203 through theInterface 1307. The nail is inserted over a Guide Wire 1301 with thisinsertion facilitated by an aligning device, such as the CannulatedOutrigger 1302 as well as Proximal Targeting Device 1303. Byinterlocking the screw 1306 alignment is assured through the AlignmentCannula 1305, with Interlocking Screw 1303 being placed utilizing thismechanism. To secure fixation between the Tibial Nail 1309 and theTibial Tray 1203 with this Contingent Prosthetic Accommodation Interface1307 is a Cannulated Coupling Interface 1308. This interface wouldprovide for fixation between 1309 and 1203. As with the previousdevices, the modification to the Tibial Tray 1203 would occur at thetime of manufacture and be present as a contingent fixation optionshould a fracture of Native Tibia Bone 1201 occur in a fracture patterndepicted as 1202.

FIG. 15 2D Rendition of (1203) Embodiment of a Prosthetic Tibial Tray

FIG. 15 represents a three-dimensional projection of an embodiment ofthe Prosthetic Tibial Tray 1203 with the Contingent ProstheticAccommodation Portal 1307. Of note there is no modification to thearticulating surface of 1203 depicted as 1501.

FIG. 16—Embodiment of Contingent Prosthetic Tibial Tray Accommodationfor Proximal Tibial Locking Plate for Management of PeriprostheticFracture Management

Depicted in FIG. 16 is an alternative embodiment of fixation forfracture of the Native Bone 1201, depicted as Fracture Pattern 1202. Theplacement of the Tibial Tray 1201 would take place at the time of totalknee arthroplasty. Fracture below the tibial tray, depicted as 1202,would occur and fixation of said fracture would be managed through themodification of the Tibial Tray 1201. The modifications in Tibial Tray1201 are made to provide for the adjoining of Custom Outrigger 1602 thatwould thread into the Modified Tibial Tray 1601 at the ProstheticContingent Mounting Interface 1608. This would be through the platelabeled 1604. All three components, 1602, 1604, and 1601 would thus beintimately joined together to provide for appropriate targeting andfixation of Screws 1606. Attached to Proximal Plate Outrigger 1602 wouldbe an aiming arm, such as Distal Targeting Device 1603 that adjoins 1602through Coupling Point 1607. Through the Distal Targeting Device 1603Alignment Cannulae 1605 are placed to align the trajectory of theInterlocking Screws 1606.

A distinct clinical advantage for the capacity to align and subsequentlymaintain the interface between the Tibial Fixation Plate 1604 and theModified Tibial Tray 1601 relates to the capacity to maintain axial,sagittal, as well as coronal plane alignment both above and belowfracture of the Native Tibia 1201, depicted as Fracture Pattern 1202.The plate is designed to be placed in a minimally invasive fashion toavoid compromise of the biology around Fracture 1202. Further clinicaladvantage is noted by the decrease in surgical time with predeterminedtargeting as well as enhanced biomechanical properties with the intimateassociation between the Tibial Plate 1604 and Modified Tibial Tray 1601.

FIG. 17: Lateral Rendition of (FIG. 16) an Embodiment of ContingentProsthetic Tibial Tray Accommodation for Proximal Tibial Locking Platefor Management of Periprosthetic Fracture Management

A lateral projection depicted in FIG. 17 reveals further detail as tothe interface between the Underlying Modified Tibial Tray 1601, TibialFixation Plate 1604, as well as the Proximal Plate Outrigger 1602 andaiming arm, such as Proximal Targeting Device 1603. This interfaceallows adjoinment of the tibial fixation plate directly to the ModifiedTibial Tray 1601 at the Interface 1608. This adjoinment is facilitatedthrough the placement of Angular Stable Interlocking Screws 1606. Theplacement being targeted through the Proximal Plate Outrigger 1602 aswell as aiming arm, such as Proximal Targeting Device 1603 and cannulae1605. With the intimate association between Tibial Tray 1601 and TibialFixation Plate 1604, the maintenance of axial, sagittal, as well ascoronal alignment is assured.

FIG. 18: Detail of an Embodiment of Tibial Contingent Accommodation andMounting of Tibial Plate

In FIG. 18 a three-dimensional depiction of an embodiment of the tibialplate fixation device is noted. The Modified Tibial Tray Component 1601would interface with Tibial Fixation Plate 1604 through the regiondepicted as 1608. Tibial Tray Contingent Plate Accommodation MountingHoles 1801 would be present at the time of manufacture. The Tibial TrayComponent 1601 would be placed at the time of total knee arthroplasty.Contingent Mounting Holes 1801 would be in place and available to beutilized for fracture fixation should the need arise. These mountingholes would accommodate the Angular Stable Locking Screw 1606 placed toprovide for an interface and secure adjoining of Tibial Fixation Plate1604 to Tibial Tray Component 1601 through Mounting Holes 1801. Thismounting interface further assures the maintenance of axial, sagittal,as well as coronal plane alignment. The Tibial Tray Contingent PlateAccommodation Mounting Holes are labeled 1801.

All of the above-described embodiments of devices provide for a varietyof fracture fixation options should a fracture occur after total hiparthroplasty or total knee arthroplasty. The current state of fixationof above-said fracture revolves around devices that are designed toavoid originally placed femoral or tibial components. The ability topre-engineer fracture fixation contingent solutions into femoral ortibial components provides for a distinct clinical advantage in theplanning and execution for periprosthetic fracture fixation. With amultitude of different fracture patterns that could clinically exist,current solutions for the variability of fracture patterns revolvearound the use of either an external bone plate or an internal medullaryrod/nail. None of the devices that currently exist have a pre-engineeredsolution to intimately associate with the previously placed total hiparthroplasty or total knee arthroplasty. The Proximal Tibial PlateContingent Mounting Holes 1801 would be in place and present at the timeof manufacture. The Tibia fixation plate and further the Tibial TrayModification 1307 Entry Portal 13 below said component. This componentbeing labeled the further construct ability the depiction of the in theFIG. 8 as well as 503 would be inserted at the time a total kneearthroplasty would be performed.

Note that the provided descriptions of embodiments are for examplepurposes only to aid in the understanding of the use of the invention.The provided embodiments, figures and discussion should not be construedas limiting the scope or application of the invention contained herein.There are variations and modification to the specific embodimentsdescribed which are intended to be included within the scope of thisinvention.

It should be understood that processes and techniques described hereinare not inherently related to any particular apparatus and may beimplemented by any suitable combination of components. Further, varioustypes of general purpose devices may be used in accordance with theteachings described herein. It may also prove advantageous to constructspecialized apparatus to perform the method steps described herein. Theinvention has been described in relation to particular examples, whichare intended in all respects to be illustrative rather than restrictive.Those skilled in the art will appreciate that many differentcombinations of hardware, software, and firmware will be suitable forpracticing the present invention. Various aspects and/or components ofthe described embodiments may be used singly or in any combination. Itis intended that the specification and examples be considered asexemplary only, with a true scope and spirit of the invention beingindicated by the claims.

While this invention has been particularly shown and described withreferences to example embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

1. A fracture fixation apparatus for securing a plurality of bonesegments including at least one fracture between the plurality of bonesegments, comprising: an intramedullary structure; one or moreintramedullary fasteners; wherein the intramedullary structure comprisesa plurality of intramedullary structure holes for accepting one or moreof the intramedullary fasteners; an extramedullary structure; one ormore angular stable extramedullary fasteners; wherein the extramedullarystructure comprises a plurality of extramedullary structure holes foraccepting one or more of the extramedullary fasteners; an aligning arm,for mechanically registering the intramedullary structure and theextramedullary structure; wherein the aligning arm comprises one or morefirst alignment features for providing mechanical alignment of at leastone of the intramedullary fasteners with respective ones of theintramedullary structure holes, so as to allow for insertion of the atleast one of the intramedullary fasteners within the respective ones ofthe intramedullary structure holes in mechanical registration; whereinthe aligning arm further comprises one or more second alignment featuresfor providing mechanical alignment of at least one of the angular stableextramedullary fasteners with respective ones of the extramedullarystructure holes, so as to allow for insertion of the at least oneangular stable extramedullary fasteners within the respective ones ofthe extramedullary structure holes in mechanical registration; andwherein the aligning arm further comprises one or more third alignmentfeatures for providing mechanical alignment of at least one additionalangular stable fastener with both at least one of the extramedullarystructure holes and with at least one of the intramedullary structureholes, so as to allow for insertion of the at least one additionalangular stable fastener within at least one respective extramedullarystructure hole and at least one respective intramedullary structure holein mechanical registration.
 2. The apparatus of claim 1 wherein theintramedullary structure is further configured to provide fixation of atleast one fracture between the plurality of bone segments.
 3. Theapparatus of claim 1 wherein the extramedullary structure is furtherconfigured to provide fixation of at least one fracture between theplurality of bone segments.
 4. The apparatus of claim 1 wherein both theextramedullary structure and the intramedullary structure are furtherconfigured to provide fixation of at least one fracture between theplurality of bone segments.
 5. The apparatus of claim 1 wherein at leastone of the one or more intramedullary fasteners fastener is an angularstable fastener.
 6. The apparatus of claim 1 wherein the at least oneadditional angular stable fastener is threaded into the intermedullarystructure.
 7. The apparatus of claim 1 wherein the one or more firstalignment features comprise respective one or more cannula.
 8. Theapparatus of claim 1 wherein the one or more second alignment featurescomprise respective one or more cannula.
 9. The apparatus of claim 1wherein the intramedullary structure is further configured to provide a)access to an intramedullary canal and b) clearance associated with atleast one feature of an in situ prothesis.
 10. The apparatus of claim 9wherein the clearance associated with the at least one feature of the insitu prothesis comprises an intercondylar notch of a distal femoralcomponent of a knee prothesis.
 11. The apparatus of claim 10 wherein theprothesis is the distal femur prothesis and is associated with anarthroplasty.
 12. The apparatus of claim 1 where at least one of theintramedullary fasteners also serves as at least one of the angularstable extramedullary fasteners.
 13. The apparatus of claim 1 where atleast one of the intramedullary fasteners also serves as at least one ofthe angular stable extramedullary fasteners and a angularly stableintermedullary fastener.
 14. The apparatus of claim 1 wherein one ormore additional angularly stable fasteners serve as a angularly stablefastener with respect to both the extramedullary structure and theintramedullary structure.
 15. The apparatus of claim 1 wherein at leastone of the angular stable extramedullary fasteners also engages theintermedullary structure.
 16. The apparatus of claim 1 furthercomprising: the intramedullary structure having an intramedullarystructure feature; the extramedullary structure having an extramedullarystructure feature; and wherein the intramedullary structure feature andthe extramedullary structure feature further enable use of theintramedullary structure together with the extramedullary structure. 17.A fracture fixation apparatus for securing a plurality of bone segmentsincluding at least one fracture associated with the plurality of bonesegments, comprising: an intramedullary structure; one or more angularstable fasteners; wherein the intramedullary structure comprises aplurality of intramedullary structure holes for accepting one or more ofthe angular stable fasteners; an extramedullary structure; wherein theextramedullary structure comprises a plurality of extramedullarystructure holes for accepting one or more of the angular stablefasteners; an aligning arm, for mechanically registering theintramedullary structure and the extramedullary structure; wherein thealigning arm comprises one or more first alignment features forproviding mechanical alignment of at least one of the intramedullarystructure holes with at least one of the extramedullary structure holesto form mechanically aligned holes; and the aligning arm furthercomprises one or more second alignment features for providing mechanicalalignment of at least one angular stable fastener with the mechanicallyaligned holes, so as to allow for insertion of the at least one angularstable fastener within at least one respective extramedullary structurehole and at least one respective intramedullary structure hole inmechanical registration.
 18. The apparatus of claim 17 wherein theintramedullary structure is further configured to provide fixation of atleast one fracture between the plurality of bone segments.
 19. Theapparatus of claim 17 wherein the extramedullary structure is furtherconfigured to provide fixation of at least one fracture between theplurality of bone segments.
 20. The apparatus of claim 17 wherein boththe extramedullary structure and intramedullary structure are furtherconfigured to provide fixation of at least one fracture between theplurality of bone segments.
 21. The apparatus of claim 17 wherein theone or more second alignment features comprise respective one or morecannula.
 22. The apparatus of claim 17 further comprising: theintramedullary structure having an intramedullary structure feature; theextramedullary structure having an extramedullary structure feature; andwherein the intramedullary structure feature and the extramedullarystructure feature further enable use of the intramedullary structuretogether with the extramedullary structure.
 23. The apparatus of claim 1wherein: the intramedullary structure is one of a plurality ofintramedullary structures each comprising a plurality of intramedullarystructure holes for accepting one or more of the intramedullaryfasteners; the extramedullary structure is one of a plurality ofextramedullary structures each comprising a plurality of extramedullarystructure holes for accepting one or more of the angular stableextramedullary fasteners; and the aligning arm is further formechanically registering the plurality of intramedullary structures withthe plurality of extramedullary structures.
 24. A method of securing anintramedullary structure to a bone, the method comprising: positioningthe intramedullary structure at least partially within the bone;positioning an extramedullary structure adjacent the bone, theextramedullary structure having a plurality of extramedullary structureholes; placing an arm in alignment with the intramedullary structure andthe extramedullary structure, such that one or more first alignmentfeatures of the arm are in alignment with a plurality of intramedullarystructure holes formed in the intramedullary structure, and such thatone or more second alignment features of the arm are in alignment withrespective ones of the plurality of extramedullary structure holes;inserting one or more intramedullary fasteners into the holes in theintramedullary structure; inserting one or more angular stableextramedullary fasteners into the extramedullary structure holes; andinserting one or more additional angular stable fasteners into at leastone extramedullary structure hole and at least one intramedullarystructure hole.
 25. The method of claim 24 wherein the intramedullarystructure provides fixation of at least one fracture between a pluralityof bone segments.
 26. The method of claim 24 wherein the extramedullarystructure provides fixation of at least one fracture between a pluralityof bone segments.
 27. The method of claim 24 wherein both theextramedullary structure and intramedullary structure provides fixationof at least one fracture between a plurality of bone segments.
 28. Themethod of claim 24 wherein at least one of the one or moreintramedullary fasteners fastener is a angular stable fastener.
 29. Themethod of claim 24 wherein the at least one additional angular stablefastener is threaded into the intermedullary structure.
 30. Theapparatus of claim 1 wherein one or more of the intramedullary structureand the extramedullary structure are further for spanning one or morefractures to provide fracture fixation.
 31. The apparatus of claim 17wherein one or more of the intramedullary structure and theextramedullary structure are further for spanning one or more fracturesto provide fracture fixation.
 32. The method of claim 24 additionallycomprising: positioning one or more of the intramedullary structure andthe extramedullary structure to span one or more fractures to providefracture fixation.